Mediators of Life-Course and Late-Life Financial Strain on Late-Life Health in Japan: Based on a Cross-Sectional Survey

Hidehiro Sugisawa; Ken Harada; Yoko Sugihara; Shizuko Yanagisawa; Masaya Shinmei

doi:10.2147/JMDH.S356760

Mediators of Life-Course and Late-Life Financial Strain on Late-Life Health in Japan: Based on a Cross-Sectional Survey

J Multidiscip Healthc. 2022 Apr 26:15:883-896. doi: 10.2147/JMDH.S356760. eCollection 2022.

Authors

Hidehiro Sugisawa¹, Ken Harada², Yoko Sugihara³, Shizuko Yanagisawa⁴, Masaya Shinmei⁵

Affiliations

¹ International Graduate School for Advanced Studies, J. F. Oberlin University, Machida-shi, Tokyo, Japan.
² Department of Humanities and Social Sciences, Jissen Women's University, Shibuya-ku, Japan.
³ Department of Urban Science and Policy, Tokyo Metropolitan University, Hachioji-shi, Japan.
⁴ Department of Oral Health Science and Social Welfare, Institute of Biomedical Sciences, Tokushima University, Tokushima-shi, Japan.
⁵ Faculty of Human Welfare, Den-En Chofu University, Kawasaki Shi, Japan.

Abstract

Purpose: Few studies have examined together the psychosocial mediators of how life-course and late-life socioeconomic status (SES) influence late-life health. This study explored psychosocial mediators of influences of not only life-course but also late-life financial strain on late-life health in Japan, using a cross-sectional survey. It was hypothesized that: 1) both life-course and late-life financial strain will influence late-life health through common mediators, and 2) such mediating influences will be large on health indicators strongly related to psychosocial resources, such as depressive tendencies and self-rated health.

Methods: The participants (N = 739) were aged 65 years and older and lived in metropolitan Tokyo, Japan. Life-course financial strain was measured retrospectively by the number of financially strenuous experiences over the participants' life-courses. Possible mediators included stressors (life-course and late-life major traumatic life events) and psychosocial resources (self-esteem, sense of control, health literacy, social networks, and social support). Health indicators included multimorbidity, disabled activities of daily living (ADL), depressive tendency, and poorer self-rated health.

Results: Having a sense of control mediated the significant influences of both life-course and late-life financial strain on disabled ADL. Furthermore, self-esteem significantly mediated the influences of both life-course and late-life financial strain on depressive tendencies and poorer self-rated health. All such mediating influences were significant at p < 0.05. Psychosocial resources did not mediate significant influences of life-course and financial strain on multimorbidity.

Conclusion: The results support our hypotheses and make three main contributions on the mechanism through which SES influences late-life health: 1) psychosocial resources mediate the effect of life-course SES on late-life health; 2) the influence differs depending on health type; and 3) these results can generalize to older adults in not only Japan but also Western countries.

Keywords: accumulative effects model; multiple health indicators; multiple mediation; self-concept; social class.

Grants and funding

This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 18H03651 (PI: Sugisawa).